{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T11:51:06Z","timestamp":1781783466998,"version":"3.54.5"},"reference-count":20,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T00:00:00Z","timestamp":1781740800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Three-level anterior cervical discectomy and fusion (ACDF) is widely used for multilevel cervical degenerative disc disease; however, the relationship between postoperative alignment trajectories, adjacent segment degeneration (ASD), and late patient-reported outcomes remains incompletely defined. This study evaluated plane-specific radiological alignment changes, MRI-based ASD, and late functional outcomes in a homogeneous three-level ACDF cohort. Methods: This single-center observational cohort included 29 patients who underwent three-level ACDF between January 2018 and December 2023 and had complete radiographic follow-up. Radiological data were collected retrospectively from institutional records and imaging archives. Cervical sagittal and coronal alignment were assessed using Cobb angles on radiographs obtained preoperatively and at 6 months, 1 year, and 2 years postoperatively. ASD was evaluated at the superior adjacent segment on 2-year MRI. Late patient-reported clinical outcomes were assessed at a mean follow-up of 42.6 \u00b1 6.8 months using the Visual Analog Scale (VAS), Neck Disability Index (NDI), and Nottingham Health Profile (NHP). Results: Sagittal Cobb angle changed significantly over time (\u03c72(3) = 12.60, p = 0.006; Kendall\u2019s W = 0.145), whereas coronal Cobb angle showed a statistically significant reduction over time, although the absolute magnitude of change was small (\u03c72(3) = 28.74, p &lt; 0.001; Kendall\u2019s W = 0.330). Lower sagittal Cobb angle correlated with worse NDI (r = \u22120.46, p = 0.004), and greater coronal Cobb angle correlated with worse physical activity scores (r = 0.52, p = 0.006). Higher Pfirrmann grade correlated with worse NDI (r = 0.49, p = 0.004) and pain scores (r = 0.44, p = 0.021). In exploratory regression analysis, sagittal Cobb angle and Pfirrmann grade were retained in the model for NDI, but these findings should be interpreted as hypothesis-generating. Conclusions: After three-level ACDF, sagittal and coronal alignment followed different postoperative trajectories. Lower sagittal alignment and greater adjacent disc degeneration were associated with worse late neck-related disability. However, given the modest sample size and exploratory nature of the regression analysis, these findings should be interpreted as hypothesis-generating. Larger prospective studies are needed to confirm whether sagittal alignment and MRI-based adjacent segment degeneration independently contribute to late functional outcomes.<\/jats:p>","DOI":"10.3390\/jcm15124739","type":"journal-article","created":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T10:25:34Z","timestamp":1781778334000},"page":"4739","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Radiological Alignment Trajectories and Late Functional Outcomes After Three-Level ACDF: A Single-Center Cohort Study"],"prefix":"10.3390","volume":"15","author":[{"given":"Merdan","family":"Orunoglu","sequence":"first","affiliation":[{"name":"Kayseri State Hospital Neurosurgery Clinic, Kocasinan 38010, Kayseri, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7094-3432","authenticated-orcid":false,"given":"Ukbe","family":"Sirayder","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Nuh Naci Yazgan University, Kocasinan 38170, Kayseri, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0888-3138","authenticated-orcid":false,"given":"Oguzhan","family":"Yilmaz","sequence":"additional","affiliation":[{"name":"Department of Therapy and Rehabilitation, Vocational School of Higher Education, Nuh Naci Yazgan University, Kocasinan 38170, Kayseri, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Murat","family":"Baloglu","sequence":"additional","affiliation":[{"name":"Eskisehir City Hospital Neurosurgery Clinic, Odunpazari 26080, Eskisehir, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,18]]},"reference":[{"key":"ref_1","first-page":"657","article-title":"Der zervikale bandscheibenvorfall","volume":"150","author":"Schnake","year":"2012","journal-title":"Z. 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